© 2001 Canadian Medical Association or its licensors
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Corticosteroids and avascular necrosis of the femoral head
Head Division of Clinical Immunology Sunnybrook and Women's College Health Sciences Centre Toronto, Ont.
Members of the Division of Orthopedics of St. Michael's Hospital in Toronto continue to maintain that a single short course of corticosteroid medication contributes to avascular necrosis of the femoral head.1 They must be reminded that avascular necrosis was reported before corticosteroids were introduced. It remains a disorder of unknown origin. The list of patients in the article by Michael McKee and colleagues includes people at high risk for avascular necrosis, such as patients with increased intracranial pressure, alcoholism and trauma.1 The authors' thinking is an example of guilt by association.
Short courses of corticosteroid therapy are widely used for life-threatening or disabling conditions, such as asthma, severe nasal polyposis, sinusitis and atopic dermatitis. The incidence of slightly over 1 case of avascular necrosis per year reported by the authors is tiny in comparison with the thousands of courses of corticosteroids appropriately prescribed over that time frame.
This report will embolden lawyers to sue physicians who appropriately prescribe short courses of corticosteroids to patients who end up with avascular necrosis, even though the evidence for a relationship is weak. Patients should indeed be warned of the side effects of short courses of corticosteroid therapy, such as weight gain, mood swings, sleep disturbance, muscle cramps and even avascular necrosis, although the last of these is extremely rare. Clinical judgement remains paramount.
Reference
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McKee MD, Waddell JP, Kudo PA, Schemitsch EH, Richards RR. Osteonecrosis of the femoral head in men following short-course corticosteroid therapy: a report of 15 cases. CMAJ 2001; 164(2):205-6.
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